Highlights
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Novel technique
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Emergency retraction
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Migrated bioprosthesis during TAVI
Abstract
We describe a case of balloon assisted retraction of a migrated CoreValve Evolut R bioprosthesis during trans-femoral TAVI.
An 87 year old man underwent a trans-femoral TAVI under local anesthetic at our institution.
Following balloon aortic valvuloplasty (BAV) with a 20 mm Nucleus balloon, a 29 mm CoreValve Evolut R bioprosthesis was deployed. The valve migrated upwards shortly after full deployment and resulted in impaired flow down the left coronary ostium and severe valvular aortic regurgitation. Cardiopulmonary resuscitation (CPR) with a Lucas device was commenced. Left ventricular wire position was lost during CPR. A 6Fr pigtail was traversed across the migrated valve and wire position was eventually regained.
To ensure rapid repositioning of the displaced valve a 25 mm Nucleus balloon was inflated across the valve and the entire scaffold retracted into the ascending aorta ( Fig. 1 A and B ). A second 29 mm CoreValve Evolut R bioprosthesis was then deployed with an excellent angiographic result and clinical outcome ( Fig. 2 and B ).
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